Soundings #2: Nobody heard him, the dead man, but still, he lay moaning…

Friday June 26, 2015 

There is a meeting today at 1.30pm at the Streatham Memorial Gardens. I shall be there early. The meeting will gather together a group of people, perhaps 100, maybe more judging from the Facebook page, who will then march up the road, not far, to the Streatham Job Centre. It is a mark of our varying dissatisfactions with the Government’s idea to put CBT therapists in Job Centres in a supposed attempt to get people ‘off the dole and back to work’.  

What a beautiful day for a protest, the roses are blooming and the birds are singing. I barely have time to look at the statue with its inscription To Our Glorious Dead and the list of names inscribed below – it’s 1.15pm and already there are 12 people standing in the shade of the trees, and two are holding up a banner which the other ten are photographing. The gist of the banner is this: ‘CBT practitioners: are you a professional or a collaborator?’ 

I set to work introducing myself and asking people why they have bothered to come today. 

“It’s a human right to be able to refuse medical treatment. To not be made to be part of an experiment. It’s written in the UN Declaration of Human Rights.”  

“I’m just gutted. Council Houses, Brixton Arches, rent increases, everything.” 

“I want to support people facing cuts to their allowances. I have friends with distress who are scared by the way things work.” 

“It seems a really bad idea to combine a disciplinary system with social care.” 

The next person turns out to be a national spokesperson for the Green Party:

“the Government is crossing a line – it’s written in their Manifesto, their intention is clear. Don’t believe them when they say there’s no coercion, it’s written in their Manifesto.” 

And others:

“Its an inappropriate setting – it is not a place to speak freely, which it should be for any therapy”. 

 “It’s wrong to make a mental health service part of a sanction system.” 

“To cut public spending, they are hitting the most vulnerable.” 

“It’s clearly wrong.” 

“Mental Health isn’t something you can flick a switch and fix”.

“The problem, in my opinion, is that we live in a system which makes us ill – unemployment, poverty. Actually I’m doing therapy, CBT, over there [points just over the main road which is throbbing with traffic fighting its way into the narrowing Streatham High Road]. The services become part of the problem. They mean well, the people who work there, but it’s done in a way that, well you are made to feel uncooperative if you turn it down. And the political, social situation is not up for discussion – these are the things we really need to talk about if we are going to get better.”  

“The problem with CBT is that it makes you the problem, and tries to change your attitude.” 

“Debt. Struggling with debt leads to suicide.” 

“I’m horrified, instead of funding mental health services in clinical settings, I had to wait six months for CBT – why not fund it more in places where people actually go to talk about their health?” 

“My girlfriend is terrified, and has taken on the language of officialdom. She says that she is a ‘shirker’! She is terrified of psychiatrists, of the ways of the medical system. She feels like a terrible burden on everybody. She has been invited to go to job centres, I go with her, but she panics in waiting rooms, and she panics when she sees the security guards – it freaks her out. She was on DLA, and they said ‘would you like to work?’, and she said ‘Yes, I would like to work!’ and they said ‘we will help you to go to work’. So we went there together, I held her hand, she wanted to work, but her expectations were really unrealistic.” 

“Its funny, they speak of parity don’t they, of parity between mental health and physical health. So, if you break your leg and can’t work, will they send you to the job centre to fix it?” 

“It’s about dignity. My partner has worked, she has paid her National Insurance, she has contributed, but now she has taken on their vocabulary, she calls herself a burden…” 

“Treatment should be voluntary. If the Job Centre should suggest that people go to the Doctor, well, are they qualified to tell people to go to the doctor? If I was working in a Job Centre I would be very uncomfortable raising it with people, because you have to be very diplomatic when you suggest to someone that they might need counselling. Even when your friend says so, you might feel offended! I mean, you have a personal relation with your job centre advisor when you are unemployed, you don’t want them prying into your personal life, do you? You have to be careful if you speak to someone about their mental health, it could be negligent to raise the question, it is a bit like the oppression we associate with Russia. When I was unemployed you had to sit in an open plan office every day for two weeks, and look for work. There were people who lectured you about looking for work. There were a lot of vulnerable there then. Imagine if you had to raise the question of mental health with someone who is clearly in distress and struggling. It could be negligent, are the people in the job centre qualified?” 

“How dare they take food away from someone, it’s against Human Rights.” 

“It is a symptom of our civilisation’s discontent, and therefore, worth punctuating. It might not be necessary, never mind possible, to remove it.” 

By this time there were about 60 people gathered in the Memorial Gardens, some holding placards and banners and others taking photos. I asked one man what he planned to do with his photos. It turned out he was a freelance photographer commissioned by the South London Press to cover the demo.  

Two women picked up the sticks to the Alliance for Counselling and Psychotherapy banner. They were sisters, and they had another sister with a learning difficulty. They told me that they were ‘watching’ and ‘listening’ to what was happening in the country with the politics, and she said, we have noticed that ‘they go for the weakest first’.  

Now we start slowly to muster together and walk across the road. A bloke rolled down his lorry’s window and shouted, “Get outta the fucking road, go get a fucking job”.  

While we edge ourselves in amongst the traffic and saunter up the main lanes of the road, I recognise someone who used to run a psychotherapy service in one of the big London hospitals. “I used to be head of psychotherapy” he said, “and I would have been raising hell against a move like this made by the management”. Who’s the head of therapy now? I asked. “A CBT guy”, he replied with a rye smile. And is he raising hell against this new policy? A derisive laugh was all that I could hear of the reply amongst the roar of the traffic and the shouts of the London drivers, who only wanted to move fast and not think about us.  

---

The paradox had not escaped her, so how had it escaped our civil servants and government ministers?

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Someone next to me said that she was concerned about therapy being put next to the Job Centre function because “it puts fear into people’s minds,” then added, “which is not desirable.”

“It is the very thing isn’t it, fear,” she went on. “This is what CBT people try to resolve, isn’t it? Yet the people who might need it most would be the ones most vulnerable to exactly this kind of fear.” The paradox had not escaped her, so how had it escaped our civil servants and government ministers, one wonders?  

People with a microphone are raising our spirits with their strong voices. There is a discreet police presence up the hill, and down the hill, and the security guards in the building are checking people’s ‘tickets’ before letting any one in. Too late! An advance guard has snuck into the building and is creeping up the stairs as we listen to the man with the mic doing his best to rouse the rabble. A few people take it in turns to move the crowd through the mic, and then a cheer goes up, and everyone moves to the other side of the street and looks up at the top floor of the building. A large red banner is unfurling in the wind with the words ‘Back To Work Therapy Is No Therapy At All’. It is now 2.30pm. 

Someone with the microphone is haranguing Ian Duncan Smith and talking about the suicides of people who have lost their benefit, and I remember Stevie Smith’s (no relation) wonderful poem ‘Not Waving, but Drowning’: Nobody heard him, the dead man, but still he lay moaning. 

Nobody heard him? We can hear him because he is not yet fully dead, only half dead, still moaning. Threatened and pushed out of the symbolic order, off the benefits, deprived of a means to live with his dignity, turned into an object, treated as any old piece of rubbish, but not yet dead. Not yet.  

In April 1953 Stevie Smith wrote her poem Not Waving but Drowning. On 1 July 1953 she self-harmed in the office and her doctor decreed that she is not emotionally stable enough to go back to work. She was retired with a small pension, and dedicated her life to writing and looking after her ailing aunt. In 1957, the publication of her collection under the heading Not Waving but Drowning established her firmly as a major poet worldwide and opens a new life for her of poetry readings and broadcasts. She soon becomes a cult poet and is sought after by the likes of John Betjeman, Philip Larkin and Sylvia Plath.  

Should we, perhaps, rather put poetry into Job Centres, and save the CBT for somewhere more fitting?

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Nobody heard him, the dead man, 

But still he lay moaning: 

I was much further out than you thought 

And not waving but drowning. 

 

Poor chap, he always loved larking 

And now he’s dead 

It must have been too cold for him his heart gave way, 

They said. 

 

Oh, no no no, it was too cold always 

(Still the dead one lay moaning) 

I was much too far out all my life 

And not waving but drowning.

 

Stevie Smith

Soundings #1

An Odd Couple: Gay Rights and State Regulation

A bill – supported (on Twitter) by the British Psychoanalytic Council – proposing the regulation of counselling and psychotherapy by the Health Professions Council [1] is awaiting its second reading [2] in Parliament on 6 June 2014. However, no sitting is expected, nor is the bill (sponsored by Labour Co-op [3] MP Geraint Davies, Swansea West) expected to become law.

It is, however, expected to become a campaign issue, and indeed, it is already showing signs of gathering support. Those in the psy-therapy field who favour state regulation are hitching their wagons to it, the motor of which, you may be surprised to hear, is gay rights.

The bill proposes that Section 60 of the Health Act 1999 (Regulation of health care and associated professions) be amended to include a paragraph requiring that a code of ethics for registered counsellors, therapists and psychotherapists must include a prohibition on gay-to-straight conversion therapy. You can read the bill here – it is one page long.

Let’s look at some of the threads that hold this ‘object’ in place.

1. Davies claims that 16 per cent of therapists practise gay conversion therapy, and cites Bartlett, Smith & King (2009) [4] to support his claim. The quote from the article actually says: “Although only 55 (4%) of [1,406 surveyed] therapists reported that they would attempt to change a client’s sexual orientation [if asked] … 222 (17%) reported having assisted at least one client/patient to reduce or change his or her homosexual or lesbian feelings.”

The major organisations, including UKCP, have responded to this by banning reparative therapy, and making it “an ethical offence” to offer it “even if asked”. In practice this seems to relate only to work done by the Association of Christian Counsellors (who are not registered under the UKCP), which leaves the wider questions which are raised here apparently undiscussed.

2. The Society of Radiographers recently considered these issues with Davies and have gone on to adopt his ideas as policy. At their Annual Delegates Conference, 7-8 April 2014, they formulated their wish to campaign with the TUC to push for counselling and psychotherapy to be given to the HCPC in order to prevent practitioners from trying to convert gays to straights. “Conference notes that gay conversion therapy has recently been evidenced as an active practice within the UK psy-scene, with one in six psychiatrists, therapists and psycho-analysts admitting to having attempted to change at least one patient’s sexuality. This practice has no medical indication and is deeply rooted in the idea that homosexuality is a mental illness.” They go on:

“Psychotherapy in the UK is an unregulated practice, with practitioners free to practise out with professional bodies and their ethical statements.  With the majority of referrals coming from general practitioners, the Government is debating a Bill to regulate psychotherapy under the Health & Care Professions Council (HCPC).  However, Norman Lamb, Minister of State for Care and Support, has said that the Government has no plans to ban conversion therapy and believes that regulation of therapists is not appropriate due to the cost to registrants and taxpayers.” And finally, the Radiographers conclude: “As a regulated profession we call on the UK Council of the Society of Radiographers to: Support the Government Bill and make it clear they believe any health and social care profession should be under statutory regulation. Work with relevant gay charities, such as Stonewall and Gay Men’s Health, to ensure that vulnerable people are protected from this unregulated practice.”

This Motion was supported by the UK Council of Radiographers and passed by Conference earlier this year. In speaking for his motion, Ross McGhee quoted Freud’s letter to an American mother in 1935, which says: “Homosexuality … is nothing to be ashamed of, no vice, no degradation. It cannot be classified as an illness; …. Many highly respectable individuals of ancient and modern times have been homosexuals, several of the greatest men among them (Plato, Michelangelo, Leonardo da Vinci, etc.). It is a great injustice to persecute homosexuality as a crime, and cruelty, too.” [5] McGhee wants to know why such enlightened opinion seems not to be figuring in the current debate.

3. Another supporter of the bill is journalist Patrick Strudwick who came to prominence in February 2010 with his article in The Independent newspaper reporting his undercover assignment to ask a Christian BACP counsellor (subsequently struck off as a result of this article) to help him to “pray away the gay”. On 24 February this year, Strudwick penned another article, this time for the Guardian supporting Davies’ bill, and concluding that: “If the government votes against this bill on Friday [6], as they have suggested they will, they will be failing every Briton – not only the one in four of us who will suffer mental ill health but everyone affected by it. They will leave you, your child, your partner, or anyone reaching out, vulnerable, scared, to quell their distress, at the mercy of the untrained, the unqualified and the unethical. This is not simply a scandal; it is an emergency.” UKCP Chief Executive David Pink wrote to the Guardian, rebutting Strudwick’s article and suggesting that the public were more at risk of harm from such simple assumptions and misleading reporting.

4. Leo Abse, famously flamboyant lawyer and former Labour MP for Pontypool (and then Torfaen) from 1958 until 1987, pioneered a private member’s bill to decriminalise homosexuality. Abse’s bill was eventually passed on 28 July 1967. This important private member’s bill is apparently being prepared for spinning by the Labour Party [7] as one of its great contributions to this country, rather than the result of the personal struggle of one of its backbenchers. You can listen to a BBC interview with Leo Abse, broadcast on 20 December 1966, here.

5. The Law Commission published its report (following the consultation on the regulation of health and social care) on 2 April this year. The 465-page document can be consulted here, and you can find its analysis of issues around ‘voluntary registers’ from paragraph 5.24 on page 60, and its “Recommendation 28: The [existing] regulators’ powers to keep voluntary registers should be removed”. This means that regulators like HCPC could not also hold a voluntary register.

6. The attempt by the then HPC to capture counselling and psychotherapy was squashed by the Judicial Review hearing at the Royal Courts of Justice, 10 December 2010. Dinah Rose QC maintained that the HPC had unlawfully failed to address critical questions about whether counselling and psychotherapy should be regulated by statute, and whether the HPC is the appropriate body to administer such regulation, given the fact that many practitioners explicitly eschew a ‘medical-model’ orientation.

Despite the HPC’s attempt to have the application ‘timed out’, Mr Justice Burton also ruled that the Judicial Review had been brought without delay and was ‘clearly arguable’. Furthermore, he criticised the misleading nature of HPC statements. For example, practitioner groups had been led to believe that the HPC would fulfil its legal responsibility to report to the Department of Health on whether it had the requisite capability to regulate the field. This never happened, and the HPC proceeded as if the requirement to report on the matter did not exist, despite acknowledging it in an early-minuted meeting. Specifically, the judge questioned the HPC’s reassuring communication to the DH in December 2009 that it had completed its exercise and was ready to accommodate the talking therapies. He invited the HPC to “reword or revise” that letter. This never happened, and the HPC’s embarrassment was allowed to fade away when the new government changed the name to HCPC, gave it the social workers to register, and told it to drop its hope of capturing counselling and psychotherapy.

The questions now are whether enlightened opinion is still against state (HCPC) regulation, whether the new voluntary regulatory mechanisms under the Professional Standards Authority (put in place by the major bodies during the last few years – BACP, UCKP etc.) are widely understood and in good use, or whether the turmoil of the 21^st century has left practitioners and public without the necessary bearings to think through these difficult issues.

For anyone who would prefer not to be defeated by rhetoric, babble, confusion and the wild commands of the super-ego, please do join the debate.

@Alliance4CP

info@allianceforcandp.org

http://www.allianceforcandp.org/

Soundings, a research report for the contemporary context of psy-praxis, is written by Janet Haney, who would like to thank colleagues for their part in supplying ideas, references, information and edits. All websites were sourced: 9-11 May 2014.

[1] The Bill cites the Health Professions Council, even though this institution has recently been renamed the Health & Care Professions Council in order to take the social workers on to its register.

[2] The ‘second reading’ is the moment for the first proper debate; the ‘first reading’ is a formality to read the title of the proposed bill into the records.

[3] The British Co-operative movement stretches back to 1844 when the Rochdale pioneers invented consumer co-operatives as a response to ‘the invisible hand’ of capitalism which was funnelling profits to a few, and leaving many to struggle.

[4] Bartlett, A., G. Smith & M. King, “The response of mental health professionals to clients seeking help to change or redirect same-sex sexual orientation”, BMC Psychiatry 2009, 9:11 

[5] Freud, Sigmund, “Letter to an American mother”, American Journal of Psychiatry, 107, 1951: p. 787.

[6] In fact this ‘first reading’ in Parliament is a formality to read the title of the Bill into the records.

[7] On-line survey taken by the author this month.